Materiały źródłowe

• #1

  https://www.nhs.uk/conditions/brain-death/

  Brain death (also known as brain stem death) is when a person on an artificial life support machine no longer has any brain functions. This means they will not regain consciousness or be able to breathe without support. […] A person who is brain dead is legally confirmed as dead. They have no chance of recovery because their body is unable to survive without artificial life support. […] If someone is brain dead, the damage is irreversible and, according to UK law, the person has died. […] But they will not ever regain consciousness or start breathing on their own again. They have already died. […] After brain death, it is not possible for someone to remain conscious. […] Brain death can also be caused by: a severe head injury, a brain haemorrhage, infections, such as encephalitis, a brain tumour.

• #2 Brain Death – Brain, Spinal Cord, and Nerve Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/brain-spinal-cord-and-nerve-disorders/coma-and-impaired-consciousness/brain-death

  Brain death means that brain function has been permanently lost and cannot resume spontaneously and cannot be restored by medical interventions. […] No treatment can help a person who is brain dead. […] No one who meets the criteria for brain death recovers. Thus, once brain death is confirmed, the person can be considered dead. […] After brain death is confirmed, all life support is stopped.

• #3 Brain Death | National Kidney Foundation

  https://www.kidney.org/kidney-topics/brain-death

  Brain death is the complete and irreversible loss of all brain function. It is diagnosed through clinical tests and confirmed by medical guidelines. […] The diagnosis of brain death is defined as „death based on the absence of all neurologic function.” […] Brain death is a legal definition of death. It is the complete stopping of all brain function and cannot be reversed. […] Before brain death is confirmed, everything possible to save an individual’s life is done. After the diagnosis of brain death is made there is no chance of recovery. […] Once the diagnosis of brain death is made, an individual is pronounced legally dead. […] A health care professional will talk with you and your family about certain decisions that need to be made at this time. Among those decisions could be removing the ventilator and the possibility of organ and/or tissue donation. […] Remember, the individual is already legally dead and removing the ventilator does not cause death.

• #4 Brain Death – EMCrit Project

  https://emcrit.org/ibcc/brain-death/

  Defined as irreversible cessation of all cerebral and brainstem functioning. […] Brain death is legally recognized as equivalent to cardiopulmonary death in the United States. […] Brain death should only be evaluated in patients with neuroimaging (e.g., CT scan) that demonstrates catastrophic brain injury compatible with brain death (e.g., herniation or severe cerebral edema). […] Potential reasons to pursue a formal diagnosis of brain death: Will resolve confusion regarding goals of care and/or issues with surrogate decision-makers. […] Ongoing high-quality supportive care is required to maximize organ function. Optimal management of the donor may increase the likelihood of successful allograft function and favorable long-term outcomes for organ recipients. […] If organ donation is not possible, medical support should be discontinued.

• #5 Diagnosis of brain death – UpToDate

  https://www.uptodate.com/contents/diagnosis-of-brain-death

  INTRODUCTION AND DEFINITION […] Death is an irreversible, biologic event that consists of permanent cessation of the critical functions of the organism as a whole. This concept allows for survival of tissues in isolation, but it requires the loss of integrated function of various organ systems. Death of the brain therefore qualifies as death, as the brain is essential for integrating critical functions of the body. The equivalence of brain death with death is largely, although not universally, accepted. […] Brain death implies the permanent absence of cerebral and brainstem functions. Although the term „brain dead” is often used colloquially in a way that erroneously encompasses patients with severe brain damage and those who remain unresponsive, in medical-legal terms its meaning is very specific.

• #6 Diagnosis of brain death – UpToDate

  https://www.uptodate.com/contents/diagnosis-of-brain-death

  Brain death signifies the complete, irreversible cessation of brain function, including the capacity for the brainstem to regulate respiratory and vegetative activities. It was first described in 1959, predating widespread organ donation, which has since made its codification critically necessary. While most countries have a legal provision for brain death, institutional protocols for diagnosis are not universal and are often absent, particularly in lower-income countries and in those without an organized transplant network. Even among countries with an organized diagnostic protocol, there is substantial variation in the criteria that are used. […] While United States law equates brain death with cardiopulmonary death, specific criteria for diagnosis are not mandated. Some states and institutions have specific diagnostic mandates, especially when applied to organ donor candidates. Most clinicians rely on published guidelines. However, surveys of academic institutions in the United States have found that there is considerable variability in adherence to published guidelines and clinical practice. Variable documentation of brain death criteria was also observed in a series of 142 children referred for organ donation, and in a chart review of 226 organ donors collected from 68 hospitals in the Midwest United States. […] In most adult series, trauma and subarachnoid hemorrhage are the most common events leading to brain death. Others include intracerebral hemorrhage, hypoxic-ischemic encephalopathy, and ischemic stroke. Any condition causing permanent widespread brain injury can lead to brain death.

• #7 Brain Death – Brain, Spinal Cord, and Nerve Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/brain-spinal-cord-and-nerve-disorders/coma-and-impaired-consciousness/brain-death

  Brain death means that brain function has been permanently lost and cannot resume spontaneously and cannot be restored by medical interventions. […] No treatment can help a person who is brain dead. […] No one who meets the criteria for brain death recovers. Thus, once brain death is confirmed, the person can be considered dead. […] After brain death is confirmed, all life support is stopped.

• #8

  https://www.nhs.uk/conditions/brain-death/

  Brain death (also known as brain stem death) is when a person on an artificial life support machine no longer has any brain functions. This means they will not regain consciousness or be able to breathe without support. […] A person who is brain dead is legally confirmed as dead. They have no chance of recovery because their body is unable to survive without artificial life support. […] If someone is brain dead, the damage is irreversible and, according to UK law, the person has died. […] But they will not ever regain consciousness or start breathing on their own again. They have already died. […] After brain death, it is not possible for someone to remain conscious. […] Brain death can also be caused by: a severe head injury, a brain haemorrhage, infections, such as encephalitis, a brain tumour.

• #9 Brain death | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/brain-death

  Brain death occurs when a critically ill person dies sometime after being placed on life support. […] In some cases, a person who is brain dead may be a candidate for organ donation. […] In some cases, a person who is brain dead may be a candidate for organ donation. If the person was a registered organ donor, or if their family knew of their wish to be an organ donor, their death is declared, but the ventilator is left on. Drugs that help preserve the internal organs are still given. The dead person then undergoes an operation to remove viable organs such as kidneys. After the operation is complete, the ventilator is switched off. Funeral arrangements can then be made by the family.

• #10 Brain Death – Brain, Spinal Cord, and Nerve Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/brain-spinal-cord-and-nerve-disorders/coma-and-impaired-consciousness/brain-death

  Brain death means that brain function has been permanently lost and cannot resume spontaneously and cannot be restored by medical interventions. […] No treatment can help a person who is brain dead. […] No one who meets the criteria for brain death recovers. Thus, once brain death is confirmed, the person can be considered dead. […] After brain death is confirmed, all life support is stopped.

• #11 Brain Death – Brain, Spinal Cord, and Nerve Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/brain-spinal-cord-and-nerve-disorders/coma-and-impaired-consciousness/brain-death

  Brain death means that brain function has been permanently lost and cannot resume spontaneously and cannot be restored by medical interventions. […] No treatment can help a person who is brain dead. […] No one who meets the criteria for brain death recovers. Thus, once brain death is confirmed, the person can be considered dead. […] After brain death is confirmed, all life support is stopped.

• #12 Brain Death – EMCrit Project

  https://emcrit.org/ibcc/brain-death/

  Defined as irreversible cessation of all cerebral and brainstem functioning. […] Brain death is legally recognized as equivalent to cardiopulmonary death in the United States. […] Brain death should only be evaluated in patients with neuroimaging (e.g., CT scan) that demonstrates catastrophic brain injury compatible with brain death (e.g., herniation or severe cerebral edema). […] Potential reasons to pursue a formal diagnosis of brain death: Will resolve confusion regarding goals of care and/or issues with surrogate decision-makers. […] Ongoing high-quality supportive care is required to maximize organ function. Optimal management of the donor may increase the likelihood of successful allograft function and favorable long-term outcomes for organ recipients. […] If organ donation is not possible, medical support should be discontinued.

• #13 Brain death | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/brain-death

  Brain death occurs when a critically ill person dies sometime after being placed on life support. […] In some cases, a person who is brain dead may be a candidate for organ donation. […] In some cases, a person who is brain dead may be a candidate for organ donation. If the person was a registered organ donor, or if their family knew of their wish to be an organ donor, their death is declared, but the ventilator is left on. Drugs that help preserve the internal organs are still given. The dead person then undergoes an operation to remove viable organs such as kidneys. After the operation is complete, the ventilator is switched off. Funeral arrangements can then be made by the family.

• #14 Withdrawing treatment after brain-stem death: A case in the Family Division – Promoting Open Justice in the Court of Protection

  https://openjusticecourtofprotection.org/2022/03/16/withdrawing-treatment-after-brain-stem-death-a-case-in-the-family-division/

  The Consultant looked exhausted. […] It is not humane to continue the treatment of a person who is brain stem dead. […] Yes, its not ethical to continue to ventilate a brain stem dead patient. […] The main thing I wish to clarify is that its becoming really unprofessional where we continue ventilating someone who is declared brain stem dead. […] From my perspective, a week is totally unacceptable from my professional perspective. […] The judge concluded by saying he had no alternative but to conclude that death had been correctly diagnosed, in accordance with the Code of Practice. It was, he said, futile for the current treatment to continue and he made the declarations requested by the Trust.

• #15 Hospitals in Kerala prolong life support for brain-dead patients despite government directive

  https://www.newindianexpress.com/states/kerala/2025/Feb/15/hospitals-in-kerala-prolong-life-support-for-brain-dead-patients-despite-government-directive

  But futile care continues. […] The practice of futile care not only misuses valuable resources but also deprives other patients of essential care in crowded tertiary hospitals. […] If a patient who has irreversible brain damage is kept on life support indefinitely, it will prevent other patients from getting the necessary treatment they need, he argued in court. […] To support doctors, K-SOTTO has over the past year trained around 200 medical professionals in both government and private hospitals to become experts in brain death certification. […] Brain death is when a persons brain stops working completely and cannot be fixed, even with treatment. […] Although the body may still be kept alive for a while with machines, the person is considered dead because the brain is no longer functioning.

• #16 Medical Management of Brain-Dead Organ Donors

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6849043/

  Appropriate medical management of a potential organ donor is a very important issue, requiring a multidisciplinary team approach for successful organ transplantation. For graft survival after donation, all available organs in the donor need to be maintained at their normal physiological condition until the time of organ retrieval. Intensivists play a vital role in the management of potential organ donors through the identification of potential donors, declaration of brain death, and proper medical care, all of which can improve the rates of graft survival. […] Data shows that progression from brain death to somatic death results in the loss of 10% to 20% of potential donor tissues, therefore timely treatment of the donor is very crucial. Strict organ-protective intensive care of the potential organ donor is therefore the first step towards a successful transplant and in the treatment of the future organ recipient.

• #17 Brain death | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/brain-death

  Brain death occurs when a critically ill person dies sometime after being placed on life support. […] In some cases, a person who is brain dead may be a candidate for organ donation. […] In some cases, a person who is brain dead may be a candidate for organ donation. If the person was a registered organ donor, or if their family knew of their wish to be an organ donor, their death is declared, but the ventilator is left on. Drugs that help preserve the internal organs are still given. The dead person then undergoes an operation to remove viable organs such as kidneys. After the operation is complete, the ventilator is switched off. Funeral arrangements can then be made by the family.

• #18 Medical Management of Brain-Dead Organ Donors

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6849043/

  Continuing care for the brain-dead donor is often critical, difficult, and complex, and may extend over several hours or even days. […] The target of management is to maintain physiological homeostasis in order to continue optimal organ function and to maximize graft viability in the organ recipient. […] The protocol we have proposed and provided in the checklist may help intensivists manage brain-dead organ donors to promote successful organ and tissue donations.

• #19 Medical Management of Brain-Dead Organ Donors

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6849043/

  Continuing care for the brain-dead donor is often critical, difficult, and complex, and may extend over several hours or even days. […] The target of management is to maintain physiological homeostasis in order to continue optimal organ function and to maximize graft viability in the organ recipient. […] The protocol we have proposed and provided in the checklist may help intensivists manage brain-dead organ donors to promote successful organ and tissue donations.

• #20 Medical Management of Brain-Dead Organ Donors

  https://www.accjournal.org/journal/view.php?doi=10.4266/acc.2019.00430

  With improving healthcare services, the demand for organ transplants has been increasing daily worldwide. Deceased organ donors serve as a good alternative option to meet this demand. The first step in this process is identifying potential organ donors. Specifically, brain-dead patients require aggressive and intensive care from the declaration of brain death until organ retrieval. Currently, there are no specific protocols in place for this, and there are notable variations in the management strategies implemented across different transplant centers. […] Intensivists play a vital role in the management of potential organ donors through the identification of potential donors, declaration of brain death, and proper medical care, all of which can improve the rates of graft survival. The protocol we have proposed and provided in the checklist may help intensivists in managing brain-dead organ donors to promote successful organ and tissue donation. […] Our proposed guideline (shown below) will help other centers to prepare their own management protocols for proper management of potential organ donors. This will increase chances of successful transplantations in the future.

• #21 Medical Management of Brain-Dead Organ Donors

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6849043/

  Continuing care for the brain-dead donor is often critical, difficult, and complex, and may extend over several hours or even days. […] The target of management is to maintain physiological homeostasis in order to continue optimal organ function and to maximize graft viability in the organ recipient. […] The protocol we have proposed and provided in the checklist may help intensivists manage brain-dead organ donors to promote successful organ and tissue donations.

• #22 Shiraz Guideline for the Management of Patients with Brain Death

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4089328/

  The purpose of this guideline is to assess the principles of maintaining brain dead cases after diagnosis in the ICU until organ removal in the surgery. […] The most important medical interventions practiced in brain dead cases include: respiratory aids and ventilator settings, hemodynamic interventions, interventions to control body fluids and electrolytes, cardiovascular aids, hormonal treatments, regulation of the body temperature, and monitoring. […] In order to avoid atelectasis and hypoxia in brain dead cases, the airways have to be kept hygienic. […] Hypotension is a common problem among brain dead patients and must be diagnosed and cured immediately. […] In brain dead patients, polyuria is defined as a situation in which the volume of urine exceeds 500 mL/h. […] To attain the hemodynamic stability of brain dead patients, various hormonal deficiencies (eg, levothyroxine, steroid, insulin deficiencies) must be taken into consideration. […] Dead-brain cases suffer from an uncontrolled central body temperature (poikilothermia) which may have abnormal influences on vital organs such as heart and liver. […] Each patient with brain death should have a CVP, arterial line, ECG, temperature, pulse Oximeter, and capnograghy monitoring.

• #23 Shiraz Guideline for the Management of Patients with Brain Death

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4089328/

  The purpose of this guideline is to assess the principles of maintaining brain dead cases after diagnosis in the ICU until organ removal in the surgery. […] The most important medical interventions practiced in brain dead cases include: respiratory aids and ventilator settings, hemodynamic interventions, interventions to control body fluids and electrolytes, cardiovascular aids, hormonal treatments, regulation of the body temperature, and monitoring. […] In order to avoid atelectasis and hypoxia in brain dead cases, the airways have to be kept hygienic. […] Hypotension is a common problem among brain dead patients and must be diagnosed and cured immediately. […] In brain dead patients, polyuria is defined as a situation in which the volume of urine exceeds 500 mL/h. […] To attain the hemodynamic stability of brain dead patients, various hormonal deficiencies (eg, levothyroxine, steroid, insulin deficiencies) must be taken into consideration. […] Dead-brain cases suffer from an uncontrolled central body temperature (poikilothermia) which may have abnormal influences on vital organs such as heart and liver. […] Each patient with brain death should have a CVP, arterial line, ECG, temperature, pulse Oximeter, and capnograghy monitoring.

• #24 Care for the brain-dead organ donor | Deranged Physiology

  https://derangedphysiology.com/main/required-reading/organ-and-tissue-donation/Chapter-615/care-brain-dead-organ-donor

  Care of the patient preparing for organ donation after brain death is essentially the support of organ systems which have lost central autonomic and endocrine regulation. The intensivist must step in to the role of the pituitary and hypothalamus, making gross adjustments to parameters which were previously handled by this apparatus. This support consists of pituitary hormone replacement and support of the functions which were formerly performed by the autonomic nervous system. Aggressive support in general (including CPR) is justified on the grounds of it being the fulfilment of the patient’s wishes, who presumably would have supported any measures which facilitate their incredibly generous act. […] The circuit should be humidified. Normoxia and normocapnea must be maintained. There will be periodic requests for ABGs on 100% FiO2 from the donor coordinator, but afterwards the FiO2 must be minimised to prevent oxidative stress damage to the lungs. Haemodynamic instability is to be expected: – The initial autonomic storm should be managed with nitroprusside and esmolol – The subsequent collapse should be treated with noradrenaline and/or vasopressin – Bradycardia will be resistant to atropine (no vagus to block); catecholamines or pacing will be required -Though they do not make a direct statement to this effect, ANZICS tacitly support CPR in the brain-dead organ donor; „cardiopulmonary resuscitation may result in recovery of cardiac function and successful transplantation”.

• #25 Shiraz Guideline for the Management of Patients with Brain Death

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4089328/

  The purpose of this guideline is to assess the principles of maintaining brain dead cases after diagnosis in the ICU until organ removal in the surgery. […] The most important medical interventions practiced in brain dead cases include: respiratory aids and ventilator settings, hemodynamic interventions, interventions to control body fluids and electrolytes, cardiovascular aids, hormonal treatments, regulation of the body temperature, and monitoring. […] In order to avoid atelectasis and hypoxia in brain dead cases, the airways have to be kept hygienic. […] Hypotension is a common problem among brain dead patients and must be diagnosed and cured immediately. […] In brain dead patients, polyuria is defined as a situation in which the volume of urine exceeds 500 mL/h. […] To attain the hemodynamic stability of brain dead patients, various hormonal deficiencies (eg, levothyroxine, steroid, insulin deficiencies) must be taken into consideration. […] Dead-brain cases suffer from an uncontrolled central body temperature (poikilothermia) which may have abnormal influences on vital organs such as heart and liver. […] Each patient with brain death should have a CVP, arterial line, ECG, temperature, pulse Oximeter, and capnograghy monitoring.

• #26 Care for the brain-dead organ donor | Deranged Physiology

  https://derangedphysiology.com/main/required-reading/organ-and-tissue-donation/Chapter-615/care-brain-dead-organ-donor

  Care of the patient preparing for organ donation after brain death is essentially the support of organ systems which have lost central autonomic and endocrine regulation. The intensivist must step in to the role of the pituitary and hypothalamus, making gross adjustments to parameters which were previously handled by this apparatus. This support consists of pituitary hormone replacement and support of the functions which were formerly performed by the autonomic nervous system. Aggressive support in general (including CPR) is justified on the grounds of it being the fulfilment of the patient’s wishes, who presumably would have supported any measures which facilitate their incredibly generous act. […] The circuit should be humidified. Normoxia and normocapnea must be maintained. There will be periodic requests for ABGs on 100% FiO2 from the donor coordinator, but afterwards the FiO2 must be minimised to prevent oxidative stress damage to the lungs. Haemodynamic instability is to be expected: – The initial autonomic storm should be managed with nitroprusside and esmolol – The subsequent collapse should be treated with noradrenaline and/or vasopressin – Bradycardia will be resistant to atropine (no vagus to block); catecholamines or pacing will be required -Though they do not make a direct statement to this effect, ANZICS tacitly support CPR in the brain-dead organ donor; „cardiopulmonary resuscitation may result in recovery of cardiac function and successful transplantation”.

• #27 Shiraz Guideline for the Management of Patients with Brain Death

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4089328/

  The purpose of this guideline is to assess the principles of maintaining brain dead cases after diagnosis in the ICU until organ removal in the surgery. […] The most important medical interventions practiced in brain dead cases include: respiratory aids and ventilator settings, hemodynamic interventions, interventions to control body fluids and electrolytes, cardiovascular aids, hormonal treatments, regulation of the body temperature, and monitoring. […] In order to avoid atelectasis and hypoxia in brain dead cases, the airways have to be kept hygienic. […] Hypotension is a common problem among brain dead patients and must be diagnosed and cured immediately. […] In brain dead patients, polyuria is defined as a situation in which the volume of urine exceeds 500 mL/h. […] To attain the hemodynamic stability of brain dead patients, various hormonal deficiencies (eg, levothyroxine, steroid, insulin deficiencies) must be taken into consideration. […] Dead-brain cases suffer from an uncontrolled central body temperature (poikilothermia) which may have abnormal influences on vital organs such as heart and liver. […] Each patient with brain death should have a CVP, arterial line, ECG, temperature, pulse Oximeter, and capnograghy monitoring.

• #28 Care for the brain-dead organ donor | Deranged Physiology

  https://derangedphysiology.com/main/required-reading/organ-and-tissue-donation/Chapter-615/care-brain-dead-organ-donor

  Care of the patient preparing for organ donation after brain death is essentially the support of organ systems which have lost central autonomic and endocrine regulation. The intensivist must step in to the role of the pituitary and hypothalamus, making gross adjustments to parameters which were previously handled by this apparatus. This support consists of pituitary hormone replacement and support of the functions which were formerly performed by the autonomic nervous system. Aggressive support in general (including CPR) is justified on the grounds of it being the fulfilment of the patient’s wishes, who presumably would have supported any measures which facilitate their incredibly generous act. […] The circuit should be humidified. Normoxia and normocapnea must be maintained. There will be periodic requests for ABGs on 100% FiO2 from the donor coordinator, but afterwards the FiO2 must be minimised to prevent oxidative stress damage to the lungs. Haemodynamic instability is to be expected: – The initial autonomic storm should be managed with nitroprusside and esmolol – The subsequent collapse should be treated with noradrenaline and/or vasopressin – Bradycardia will be resistant to atropine (no vagus to block); catecholamines or pacing will be required -Though they do not make a direct statement to this effect, ANZICS tacitly support CPR in the brain-dead organ donor; „cardiopulmonary resuscitation may result in recovery of cardiac function and successful transplantation”.

• #29 Care for the brain-dead organ donor | Deranged Physiology

  https://derangedphysiology.com/main/required-reading/organ-and-tissue-donation/Chapter-615/care-brain-dead-organ-donor

  Care of the patient preparing for organ donation after brain death is essentially the support of organ systems which have lost central autonomic and endocrine regulation. The intensivist must step in to the role of the pituitary and hypothalamus, making gross adjustments to parameters which were previously handled by this apparatus. This support consists of pituitary hormone replacement and support of the functions which were formerly performed by the autonomic nervous system. Aggressive support in general (including CPR) is justified on the grounds of it being the fulfilment of the patient’s wishes, who presumably would have supported any measures which facilitate their incredibly generous act. […] The circuit should be humidified. Normoxia and normocapnea must be maintained. There will be periodic requests for ABGs on 100% FiO2 from the donor coordinator, but afterwards the FiO2 must be minimised to prevent oxidative stress damage to the lungs. Haemodynamic instability is to be expected: – The initial autonomic storm should be managed with nitroprusside and esmolol – The subsequent collapse should be treated with noradrenaline and/or vasopressin – Bradycardia will be resistant to atropine (no vagus to block); catecholamines or pacing will be required -Though they do not make a direct statement to this effect, ANZICS tacitly support CPR in the brain-dead organ donor; „cardiopulmonary resuscitation may result in recovery of cardiac function and successful transplantation”.

• #30 Shiraz Guideline for the Management of Patients with Brain Death

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4089328/

  The purpose of this guideline is to assess the principles of maintaining brain dead cases after diagnosis in the ICU until organ removal in the surgery. […] The most important medical interventions practiced in brain dead cases include: respiratory aids and ventilator settings, hemodynamic interventions, interventions to control body fluids and electrolytes, cardiovascular aids, hormonal treatments, regulation of the body temperature, and monitoring. […] In order to avoid atelectasis and hypoxia in brain dead cases, the airways have to be kept hygienic. […] Hypotension is a common problem among brain dead patients and must be diagnosed and cured immediately. […] In brain dead patients, polyuria is defined as a situation in which the volume of urine exceeds 500 mL/h. […] To attain the hemodynamic stability of brain dead patients, various hormonal deficiencies (eg, levothyroxine, steroid, insulin deficiencies) must be taken into consideration. […] Dead-brain cases suffer from an uncontrolled central body temperature (poikilothermia) which may have abnormal influences on vital organs such as heart and liver. […] Each patient with brain death should have a CVP, arterial line, ECG, temperature, pulse Oximeter, and capnograghy monitoring.

• #31 Shiraz Guideline for the Management of Patients with Brain Death

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4089328/

  The purpose of this guideline is to assess the principles of maintaining brain dead cases after diagnosis in the ICU until organ removal in the surgery. […] The most important medical interventions practiced in brain dead cases include: respiratory aids and ventilator settings, hemodynamic interventions, interventions to control body fluids and electrolytes, cardiovascular aids, hormonal treatments, regulation of the body temperature, and monitoring. […] In order to avoid atelectasis and hypoxia in brain dead cases, the airways have to be kept hygienic. […] Hypotension is a common problem among brain dead patients and must be diagnosed and cured immediately. […] In brain dead patients, polyuria is defined as a situation in which the volume of urine exceeds 500 mL/h. […] To attain the hemodynamic stability of brain dead patients, various hormonal deficiencies (eg, levothyroxine, steroid, insulin deficiencies) must be taken into consideration. […] Dead-brain cases suffer from an uncontrolled central body temperature (poikilothermia) which may have abnormal influences on vital organs such as heart and liver. […] Each patient with brain death should have a CVP, arterial line, ECG, temperature, pulse Oximeter, and capnograghy monitoring.

• #32

  https://link.springer.com/article/10.1007/s00134-019-05551-y

  Most elements in the current recommendations and guidelines are based on pathophysiological reasoning, epidemiological observations, or extrapolations from general ICU management strategies, and not on evidence from randomized controlled trials. […] The cardiorespiratory management of brain-dead donors is very similar to the management of critically ill patients, and the same applies to the management of anaemia and coagulation. […] Central diabetes insipidus is of particular concern, and should be diagnosed based on clinical criteria. Depending on the degree of vasopressor dependency, it can be treated with intermittent desmopressin or continuous vasopressin, intravenously. […] The indications and controversies regarding endocrine therapies, in particular thyroid hormone replacement therapy, and corticosteroid therapy, are discussed. […] The potential donor should be assessed clinically for infections, and screening tests for specific infections are an essential part of donor management. […] However, new antiviral drugs and strategies now allow organ donation from certain infected donors to be done safely.

• #33 Shiraz Guideline for the Management of Patients with Brain Death

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4089328/

  The purpose of this guideline is to assess the principles of maintaining brain dead cases after diagnosis in the ICU until organ removal in the surgery. […] The most important medical interventions practiced in brain dead cases include: respiratory aids and ventilator settings, hemodynamic interventions, interventions to control body fluids and electrolytes, cardiovascular aids, hormonal treatments, regulation of the body temperature, and monitoring. […] In order to avoid atelectasis and hypoxia in brain dead cases, the airways have to be kept hygienic. […] Hypotension is a common problem among brain dead patients and must be diagnosed and cured immediately. […] In brain dead patients, polyuria is defined as a situation in which the volume of urine exceeds 500 mL/h. […] To attain the hemodynamic stability of brain dead patients, various hormonal deficiencies (eg, levothyroxine, steroid, insulin deficiencies) must be taken into consideration. […] Dead-brain cases suffer from an uncontrolled central body temperature (poikilothermia) which may have abnormal influences on vital organs such as heart and liver. […] Each patient with brain death should have a CVP, arterial line, ECG, temperature, pulse Oximeter, and capnograghy monitoring.

• #34

  https://link.springer.com/article/10.1007/s00134-019-05551-y

  Most elements in the current recommendations and guidelines are based on pathophysiological reasoning, epidemiological observations, or extrapolations from general ICU management strategies, and not on evidence from randomized controlled trials. […] The cardiorespiratory management of brain-dead donors is very similar to the management of critically ill patients, and the same applies to the management of anaemia and coagulation. […] Central diabetes insipidus is of particular concern, and should be diagnosed based on clinical criteria. Depending on the degree of vasopressor dependency, it can be treated with intermittent desmopressin or continuous vasopressin, intravenously. […] The indications and controversies regarding endocrine therapies, in particular thyroid hormone replacement therapy, and corticosteroid therapy, are discussed. […] The potential donor should be assessed clinically for infections, and screening tests for specific infections are an essential part of donor management. […] However, new antiviral drugs and strategies now allow organ donation from certain infected donors to be done safely.

• #35 Organ Donation New Zealand | 4 | Physiological support after brain death

  https://donor.co.nz/healthcare-professionals/intensive-care-unit-guidelines/4-physiological-support-after-brain-death/

  It is very important to recognise and treat DI early. […] Donor hyperosmolality has been associated with impaired organ function in some liver recipients. […] The anaesthetist should aim to maintain stability in the donor until aortic cross-clamp. This is to ensure the organs being donated for transplantation are in optimal condition when removed and will function well in recipients following transplantation. […] These treatments are recommended in the ANZICS Statement and by ODNZ. […] It is important for ICU and OT staff to understand that the patient is not receiving an anaesthetic as such. Anaesthesia is not required in patients who are brain dead.

• #36 Shiraz Guideline for the Management of Patients with Brain Death

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4089328/

  The purpose of this guideline is to assess the principles of maintaining brain dead cases after diagnosis in the ICU until organ removal in the surgery. […] The most important medical interventions practiced in brain dead cases include: respiratory aids and ventilator settings, hemodynamic interventions, interventions to control body fluids and electrolytes, cardiovascular aids, hormonal treatments, regulation of the body temperature, and monitoring. […] In order to avoid atelectasis and hypoxia in brain dead cases, the airways have to be kept hygienic. […] Hypotension is a common problem among brain dead patients and must be diagnosed and cured immediately. […] In brain dead patients, polyuria is defined as a situation in which the volume of urine exceeds 500 mL/h. […] To attain the hemodynamic stability of brain dead patients, various hormonal deficiencies (eg, levothyroxine, steroid, insulin deficiencies) must be taken into consideration. […] Dead-brain cases suffer from an uncontrolled central body temperature (poikilothermia) which may have abnormal influences on vital organs such as heart and liver. […] Each patient with brain death should have a CVP, arterial line, ECG, temperature, pulse Oximeter, and capnograghy monitoring.

• #37

  https://link.springer.com/article/10.1007/s00134-019-05551-y

  Most elements in the current recommendations and guidelines are based on pathophysiological reasoning, epidemiological observations, or extrapolations from general ICU management strategies, and not on evidence from randomized controlled trials. […] The cardiorespiratory management of brain-dead donors is very similar to the management of critically ill patients, and the same applies to the management of anaemia and coagulation. […] Central diabetes insipidus is of particular concern, and should be diagnosed based on clinical criteria. Depending on the degree of vasopressor dependency, it can be treated with intermittent desmopressin or continuous vasopressin, intravenously. […] The indications and controversies regarding endocrine therapies, in particular thyroid hormone replacement therapy, and corticosteroid therapy, are discussed. […] The potential donor should be assessed clinically for infections, and screening tests for specific infections are an essential part of donor management. […] However, new antiviral drugs and strategies now allow organ donation from certain infected donors to be done safely.

• #38 Management of Brain-Dead Donor for Organ Transplant : Virtual Library

  https://resources.wfsahq.org/atotw/management-of-brain-dead-donor-for-organ-transplant/

  The United Network for Organ Sharing (UNOS) Critical Pathway for the Organ Donor suggests a protocol of hormone replacement therapy (HRT) of levothyroxine, insulin, methylprednisolone, and possibly vasopressin when indicated. HRT has been found to improve cardiac graft outcomes. […] Organ preservation is a continuum which starts with the optimal management of the potential organ donor and continues during procurement and storage with the aim of increasing the likelihood of procurement in potential donors, the yield of transplantable organs per donor, and improving graft function after transplantation.

• #39 Management of Brain-Dead Donor for Organ Transplant : Virtual Library

  https://resources.wfsahq.org/atotw/management-of-brain-dead-donor-for-organ-transplant/

  The United Network for Organ Sharing (UNOS) Critical Pathway for the Organ Donor suggests a protocol of hormone replacement therapy (HRT) of levothyroxine, insulin, methylprednisolone, and possibly vasopressin when indicated. HRT has been found to improve cardiac graft outcomes. […] Organ preservation is a continuum which starts with the optimal management of the potential organ donor and continues during procurement and storage with the aim of increasing the likelihood of procurement in potential donors, the yield of transplantable organs per donor, and improving graft function after transplantation.

• #40

  https://link.springer.com/article/10.1007/s00134-019-05551-y

  Most elements in the current recommendations and guidelines are based on pathophysiological reasoning, epidemiological observations, or extrapolations from general ICU management strategies, and not on evidence from randomized controlled trials. […] The cardiorespiratory management of brain-dead donors is very similar to the management of critically ill patients, and the same applies to the management of anaemia and coagulation. […] Central diabetes insipidus is of particular concern, and should be diagnosed based on clinical criteria. Depending on the degree of vasopressor dependency, it can be treated with intermittent desmopressin or continuous vasopressin, intravenously. […] The indications and controversies regarding endocrine therapies, in particular thyroid hormone replacement therapy, and corticosteroid therapy, are discussed. […] The potential donor should be assessed clinically for infections, and screening tests for specific infections are an essential part of donor management. […] However, new antiviral drugs and strategies now allow organ donation from certain infected donors to be done safely.

• #41 Management of Brain-Dead Donor for Organ Transplant : Virtual Library

  https://resources.wfsahq.org/atotw/management-of-brain-dead-donor-for-organ-transplant/

  The United Network for Organ Sharing (UNOS) Critical Pathway for the Organ Donor suggests a protocol of hormone replacement therapy (HRT) of levothyroxine, insulin, methylprednisolone, and possibly vasopressin when indicated. HRT has been found to improve cardiac graft outcomes. […] Organ preservation is a continuum which starts with the optimal management of the potential organ donor and continues during procurement and storage with the aim of increasing the likelihood of procurement in potential donors, the yield of transplantable organs per donor, and improving graft function after transplantation.

• #42 Shiraz Guideline for the Management of Patients with Brain Death

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4089328/

  The purpose of this guideline is to assess the principles of maintaining brain dead cases after diagnosis in the ICU until organ removal in the surgery. […] The most important medical interventions practiced in brain dead cases include: respiratory aids and ventilator settings, hemodynamic interventions, interventions to control body fluids and electrolytes, cardiovascular aids, hormonal treatments, regulation of the body temperature, and monitoring. […] In order to avoid atelectasis and hypoxia in brain dead cases, the airways have to be kept hygienic. […] Hypotension is a common problem among brain dead patients and must be diagnosed and cured immediately. […] In brain dead patients, polyuria is defined as a situation in which the volume of urine exceeds 500 mL/h. […] To attain the hemodynamic stability of brain dead patients, various hormonal deficiencies (eg, levothyroxine, steroid, insulin deficiencies) must be taken into consideration. […] Dead-brain cases suffer from an uncontrolled central body temperature (poikilothermia) which may have abnormal influences on vital organs such as heart and liver. […] Each patient with brain death should have a CVP, arterial line, ECG, temperature, pulse Oximeter, and capnograghy monitoring.

• #43 Organ Donation New Zealand | 4 | Physiological support after brain death

  https://donor.co.nz/healthcare-professionals/intensive-care-unit-guidelines/4-physiological-support-after-brain-death/

  This section of the ODNZ ICU Guidelines provides guidance on maintaining stability during the development of brain death until the donor surgery. Brain death is associated with specific physiological changes which should be treated early to avoid instability. […] To preserve the option of donation of the maximum number of organs for transplantation. […] It is important to prevent hypothermia developing. […] The outcome for lung recipients, especially in the early post-transplant period, is dependent on the degree of lung dysfunction in the donor. It is important to ensure that all aspects of lung function of the donor are as good as possible. […] With appropriate therapy cardiac function can recover in some donors. […] This produces relative hypovolaemia and some blood volume expansion with resuscitation fluids (eg PL-148 or 0.9% saline) is usually needed at this time.

• #44 Shiraz Guideline for the Management of Patients with Brain Death

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4089328/

  The purpose of this guideline is to assess the principles of maintaining brain dead cases after diagnosis in the ICU until organ removal in the surgery. […] The most important medical interventions practiced in brain dead cases include: respiratory aids and ventilator settings, hemodynamic interventions, interventions to control body fluids and electrolytes, cardiovascular aids, hormonal treatments, regulation of the body temperature, and monitoring. […] In order to avoid atelectasis and hypoxia in brain dead cases, the airways have to be kept hygienic. […] Hypotension is a common problem among brain dead patients and must be diagnosed and cured immediately. […] In brain dead patients, polyuria is defined as a situation in which the volume of urine exceeds 500 mL/h. […] To attain the hemodynamic stability of brain dead patients, various hormonal deficiencies (eg, levothyroxine, steroid, insulin deficiencies) must be taken into consideration. […] Dead-brain cases suffer from an uncontrolled central body temperature (poikilothermia) which may have abnormal influences on vital organs such as heart and liver. […] Each patient with brain death should have a CVP, arterial line, ECG, temperature, pulse Oximeter, and capnograghy monitoring.

• #45 Organ Donation New Zealand | 4 | Physiological support after brain death

  https://donor.co.nz/healthcare-professionals/intensive-care-unit-guidelines/4-physiological-support-after-brain-death/

  This section of the ODNZ ICU Guidelines provides guidance on maintaining stability during the development of brain death until the donor surgery. Brain death is associated with specific physiological changes which should be treated early to avoid instability. […] To preserve the option of donation of the maximum number of organs for transplantation. […] It is important to prevent hypothermia developing. […] The outcome for lung recipients, especially in the early post-transplant period, is dependent on the degree of lung dysfunction in the donor. It is important to ensure that all aspects of lung function of the donor are as good as possible. […] With appropriate therapy cardiac function can recover in some donors. […] This produces relative hypovolaemia and some blood volume expansion with resuscitation fluids (eg PL-148 or 0.9% saline) is usually needed at this time.

• #46 Shiraz Guideline for the Management of Patients with Brain Death

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4089328/

  The purpose of this guideline is to assess the principles of maintaining brain dead cases after diagnosis in the ICU until organ removal in the surgery. […] The most important medical interventions practiced in brain dead cases include: respiratory aids and ventilator settings, hemodynamic interventions, interventions to control body fluids and electrolytes, cardiovascular aids, hormonal treatments, regulation of the body temperature, and monitoring. […] In order to avoid atelectasis and hypoxia in brain dead cases, the airways have to be kept hygienic. […] Hypotension is a common problem among brain dead patients and must be diagnosed and cured immediately. […] In brain dead patients, polyuria is defined as a situation in which the volume of urine exceeds 500 mL/h. […] To attain the hemodynamic stability of brain dead patients, various hormonal deficiencies (eg, levothyroxine, steroid, insulin deficiencies) must be taken into consideration. […] Dead-brain cases suffer from an uncontrolled central body temperature (poikilothermia) which may have abnormal influences on vital organs such as heart and liver. […] Each patient with brain death should have a CVP, arterial line, ECG, temperature, pulse Oximeter, and capnograghy monitoring.

• #47 Shiraz Guideline for the Management of Patients with Brain Death

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4089328/

  The purpose of this guideline is to assess the principles of maintaining brain dead cases after diagnosis in the ICU until organ removal in the surgery. […] The most important medical interventions practiced in brain dead cases include: respiratory aids and ventilator settings, hemodynamic interventions, interventions to control body fluids and electrolytes, cardiovascular aids, hormonal treatments, regulation of the body temperature, and monitoring. […] In order to avoid atelectasis and hypoxia in brain dead cases, the airways have to be kept hygienic. […] Hypotension is a common problem among brain dead patients and must be diagnosed and cured immediately. […] In brain dead patients, polyuria is defined as a situation in which the volume of urine exceeds 500 mL/h. […] To attain the hemodynamic stability of brain dead patients, various hormonal deficiencies (eg, levothyroxine, steroid, insulin deficiencies) must be taken into consideration. […] Dead-brain cases suffer from an uncontrolled central body temperature (poikilothermia) which may have abnormal influences on vital organs such as heart and liver. […] Each patient with brain death should have a CVP, arterial line, ECG, temperature, pulse Oximeter, and capnograghy monitoring.

• #48

  https://link.springer.com/article/10.1007/s00134-019-05551-y

  Most elements in the current recommendations and guidelines are based on pathophysiological reasoning, epidemiological observations, or extrapolations from general ICU management strategies, and not on evidence from randomized controlled trials. […] The cardiorespiratory management of brain-dead donors is very similar to the management of critically ill patients, and the same applies to the management of anaemia and coagulation. […] Central diabetes insipidus is of particular concern, and should be diagnosed based on clinical criteria. Depending on the degree of vasopressor dependency, it can be treated with intermittent desmopressin or continuous vasopressin, intravenously. […] The indications and controversies regarding endocrine therapies, in particular thyroid hormone replacement therapy, and corticosteroid therapy, are discussed. […] The potential donor should be assessed clinically for infections, and screening tests for specific infections are an essential part of donor management. […] However, new antiviral drugs and strategies now allow organ donation from certain infected donors to be done safely.

• #49

  https://link.springer.com/article/10.1007/s00134-019-05551-y

  Most elements in the current recommendations and guidelines are based on pathophysiological reasoning, epidemiological observations, or extrapolations from general ICU management strategies, and not on evidence from randomized controlled trials. […] The cardiorespiratory management of brain-dead donors is very similar to the management of critically ill patients, and the same applies to the management of anaemia and coagulation. […] Central diabetes insipidus is of particular concern, and should be diagnosed based on clinical criteria. Depending on the degree of vasopressor dependency, it can be treated with intermittent desmopressin or continuous vasopressin, intravenously. […] The indications and controversies regarding endocrine therapies, in particular thyroid hormone replacement therapy, and corticosteroid therapy, are discussed. […] The potential donor should be assessed clinically for infections, and screening tests for specific infections are an essential part of donor management. […] However, new antiviral drugs and strategies now allow organ donation from certain infected donors to be done safely.

• #50

  https://link.springer.com/article/10.1007/s00134-019-05551-y

  Most elements in the current recommendations and guidelines are based on pathophysiological reasoning, epidemiological observations, or extrapolations from general ICU management strategies, and not on evidence from randomized controlled trials. […] The cardiorespiratory management of brain-dead donors is very similar to the management of critically ill patients, and the same applies to the management of anaemia and coagulation. […] Central diabetes insipidus is of particular concern, and should be diagnosed based on clinical criteria. Depending on the degree of vasopressor dependency, it can be treated with intermittent desmopressin or continuous vasopressin, intravenously. […] The indications and controversies regarding endocrine therapies, in particular thyroid hormone replacement therapy, and corticosteroid therapy, are discussed. […] The potential donor should be assessed clinically for infections, and screening tests for specific infections are an essential part of donor management. […] However, new antiviral drugs and strategies now allow organ donation from certain infected donors to be done safely.

• #51 Medical Management of Brain-Dead Organ Donors

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6849043/

  With improving healthcare services, the demand for organ transplants has been increasing daily worldwide. Deceased organ donors serve as a good alternative option to meet this demand. The first step in this process is identifying potential organ donors. Specifically, brain-dead patients require aggressive and intensive care from the declaration of brain death until organ retrieval. […] Currently, there are no specific protocols in place for this, and there are notable variations in the management strategies implemented across different transplant centers. Some transplant centers follow their own treatment protocols, whereas other countries, such as Bangladesh, do not have any protocols for potential organ donor care. In this review, we discuss how to identify brain-dead donors and describe the physiological changes that occur following brain death. We then summarize the management of brain-dead organ donors and, on the basis of a review of the literature, we propose recommendations for a treatment protocol to be developed in the future.

• #52 Medical Management of Brain-Dead Organ Donors

  https://www.accjournal.org/journal/view.php?doi=10.4266/acc.2019.00430

  With improving healthcare services, the demand for organ transplants has been increasing daily worldwide. Deceased organ donors serve as a good alternative option to meet this demand. The first step in this process is identifying potential organ donors. Specifically, brain-dead patients require aggressive and intensive care from the declaration of brain death until organ retrieval. Currently, there are no specific protocols in place for this, and there are notable variations in the management strategies implemented across different transplant centers. […] Intensivists play a vital role in the management of potential organ donors through the identification of potential donors, declaration of brain death, and proper medical care, all of which can improve the rates of graft survival. The protocol we have proposed and provided in the checklist may help intensivists in managing brain-dead organ donors to promote successful organ and tissue donation. […] Our proposed guideline (shown below) will help other centers to prepare their own management protocols for proper management of potential organ donors. This will increase chances of successful transplantations in the future.

• #53 Medical Management of Brain-Dead Organ Donors

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6849043/

  With improving healthcare services, the demand for organ transplants has been increasing daily worldwide. Deceased organ donors serve as a good alternative option to meet this demand. The first step in this process is identifying potential organ donors. Specifically, brain-dead patients require aggressive and intensive care from the declaration of brain death until organ retrieval. […] Currently, there are no specific protocols in place for this, and there are notable variations in the management strategies implemented across different transplant centers. Some transplant centers follow their own treatment protocols, whereas other countries, such as Bangladesh, do not have any protocols for potential organ donor care. In this review, we discuss how to identify brain-dead donors and describe the physiological changes that occur following brain death. We then summarize the management of brain-dead organ donors and, on the basis of a review of the literature, we propose recommendations for a treatment protocol to be developed in the future.

• #54

  https://link.springer.com/article/10.1007/s00134-019-05551-y

  Most elements in the current recommendations and guidelines are based on pathophysiological reasoning, epidemiological observations, or extrapolations from general ICU management strategies, and not on evidence from randomized controlled trials. […] The cardiorespiratory management of brain-dead donors is very similar to the management of critically ill patients, and the same applies to the management of anaemia and coagulation. […] Central diabetes insipidus is of particular concern, and should be diagnosed based on clinical criteria. Depending on the degree of vasopressor dependency, it can be treated with intermittent desmopressin or continuous vasopressin, intravenously. […] The indications and controversies regarding endocrine therapies, in particular thyroid hormone replacement therapy, and corticosteroid therapy, are discussed. […] The potential donor should be assessed clinically for infections, and screening tests for specific infections are an essential part of donor management. […] However, new antiviral drugs and strategies now allow organ donation from certain infected donors to be done safely.

• #55

  https://link.springer.com/article/10.1007/s00134-019-05551-y

  Most elements in the current recommendations and guidelines are based on pathophysiological reasoning, epidemiological observations, or extrapolations from general ICU management strategies, and not on evidence from randomized controlled trials. […] The cardiorespiratory management of brain-dead donors is very similar to the management of critically ill patients, and the same applies to the management of anaemia and coagulation. […] Central diabetes insipidus is of particular concern, and should be diagnosed based on clinical criteria. Depending on the degree of vasopressor dependency, it can be treated with intermittent desmopressin or continuous vasopressin, intravenously. […] The indications and controversies regarding endocrine therapies, in particular thyroid hormone replacement therapy, and corticosteroid therapy, are discussed. […] The potential donor should be assessed clinically for infections, and screening tests for specific infections are an essential part of donor management. […] However, new antiviral drugs and strategies now allow organ donation from certain infected donors to be done safely.

• #56 Medical Management of Brain-Dead Organ Donors

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6849043/

  Continuing care for the brain-dead donor is often critical, difficult, and complex, and may extend over several hours or even days. […] The target of management is to maintain physiological homeostasis in order to continue optimal organ function and to maximize graft viability in the organ recipient. […] The protocol we have proposed and provided in the checklist may help intensivists manage brain-dead organ donors to promote successful organ and tissue donations.

• #57 Medical Management of Brain-Dead Organ Donors

  https://www.accjournal.org/journal/view.php?doi=10.4266/acc.2019.00430

  With improving healthcare services, the demand for organ transplants has been increasing daily worldwide. Deceased organ donors serve as a good alternative option to meet this demand. The first step in this process is identifying potential organ donors. Specifically, brain-dead patients require aggressive and intensive care from the declaration of brain death until organ retrieval. Currently, there are no specific protocols in place for this, and there are notable variations in the management strategies implemented across different transplant centers. […] Intensivists play a vital role in the management of potential organ donors through the identification of potential donors, declaration of brain death, and proper medical care, all of which can improve the rates of graft survival. The protocol we have proposed and provided in the checklist may help intensivists in managing brain-dead organ donors to promote successful organ and tissue donation. […] Our proposed guideline (shown below) will help other centers to prepare their own management protocols for proper management of potential organ donors. This will increase chances of successful transplantations in the future.

• #58 Care for the brain-dead organ donor | Deranged Physiology

  https://derangedphysiology.com/main/required-reading/organ-and-tissue-donation/Chapter-615/care-brain-dead-organ-donor

  Though they do not make a direct statement to this effect, ANZICS tacitly support CPR in the brain-dead organ donor; „cardiopulmonary resuscitation may result in recovery of cardiac function and successful transplantation”. A recent review (Dalle Ave et al, 2015) discusses the practice of “Organ preserving cardiopulmonary resuscitation (OP-CPR)”. This is defined as the use of CPR in cases of cardiac arrest to preserve organs for transplantation, rather than to revive the patient. Is it ethical? The authors concluded that yes, it is. OP-CPR can benefit patients and families by fulfilling the wish to donate. Specific (and very sensible-sounding) guidelines were suggested: In a brain-dead organ donor: CPR is acceptable without specific informed consent. If brain death has yet to be determined, BUT the patient had a known wish to donate: CPR would only be acceptable with a specific informed consent from the next of kin. If futility of treatment has not been established, OR it is uncertain if the patient wished to be an organ donor, then OP-CPR should be prohibited, in order to avoid any conflict of interest.

• #59 Care for the brain-dead organ donor | Deranged Physiology

  https://derangedphysiology.com/main/required-reading/organ-and-tissue-donation/Chapter-615/care-brain-dead-organ-donor

  Though they do not make a direct statement to this effect, ANZICS tacitly support CPR in the brain-dead organ donor; „cardiopulmonary resuscitation may result in recovery of cardiac function and successful transplantation”. A recent review (Dalle Ave et al, 2015) discusses the practice of “Organ preserving cardiopulmonary resuscitation (OP-CPR)”. This is defined as the use of CPR in cases of cardiac arrest to preserve organs for transplantation, rather than to revive the patient. Is it ethical? The authors concluded that yes, it is. OP-CPR can benefit patients and families by fulfilling the wish to donate. Specific (and very sensible-sounding) guidelines were suggested: In a brain-dead organ donor: CPR is acceptable without specific informed consent. If brain death has yet to be determined, BUT the patient had a known wish to donate: CPR would only be acceptable with a specific informed consent from the next of kin. If futility of treatment has not been established, OR it is uncertain if the patient wished to be an organ donor, then OP-CPR should be prohibited, in order to avoid any conflict of interest.

• #60 Management of Brain-Dead Donor for Organ Transplant : Virtual Library

  https://resources.wfsahq.org/atotw/management-of-brain-dead-donor-for-organ-transplant/

  Organ transplantation is the treatment of choice for end-organ failure. Organs are sourced from living donors, donors declared dead by cardiopulmonary criteria, or donors declared brain dead by neurologic criteria. […] The ventilation, infusion and pumping, pharmacological treatment and specificities (VIPPS) strategy is a mnemonic method that brings together key aspects of the restoration of oxygen delivery to tissues during hemodynamic instability plus organ optimization strategies. […] Organ-preserving cardiopulmonary resuscitation is defined as the use of cardiopulmonary resuscitation in cases of cardiac arrest to preserve organs for transplantation, rather than to revive the patient. […] Declaration of brain death and subsequent management of potential donors for organ transplant along with obtaining the consent of the family for procurement is a highly sensitive issue and requires consideration and multidisciplinary effort by the hospital staff and the organ procurement team.

• #61 Care for the brain-dead organ donor | Deranged Physiology

  https://derangedphysiology.com/main/required-reading/organ-and-tissue-donation/Chapter-615/care-brain-dead-organ-donor

  Though they do not make a direct statement to this effect, ANZICS tacitly support CPR in the brain-dead organ donor; „cardiopulmonary resuscitation may result in recovery of cardiac function and successful transplantation”. A recent review (Dalle Ave et al, 2015) discusses the practice of “Organ preserving cardiopulmonary resuscitation (OP-CPR)”. This is defined as the use of CPR in cases of cardiac arrest to preserve organs for transplantation, rather than to revive the patient. Is it ethical? The authors concluded that yes, it is. OP-CPR can benefit patients and families by fulfilling the wish to donate. Specific (and very sensible-sounding) guidelines were suggested: In a brain-dead organ donor: CPR is acceptable without specific informed consent. If brain death has yet to be determined, BUT the patient had a known wish to donate: CPR would only be acceptable with a specific informed consent from the next of kin. If futility of treatment has not been established, OR it is uncertain if the patient wished to be an organ donor, then OP-CPR should be prohibited, in order to avoid any conflict of interest.

• #62 Care for the brain-dead organ donor | Deranged Physiology

  https://derangedphysiology.com/main/required-reading/organ-and-tissue-donation/Chapter-615/care-brain-dead-organ-donor

  Though they do not make a direct statement to this effect, ANZICS tacitly support CPR in the brain-dead organ donor; „cardiopulmonary resuscitation may result in recovery of cardiac function and successful transplantation”. A recent review (Dalle Ave et al, 2015) discusses the practice of “Organ preserving cardiopulmonary resuscitation (OP-CPR)”. This is defined as the use of CPR in cases of cardiac arrest to preserve organs for transplantation, rather than to revive the patient. Is it ethical? The authors concluded that yes, it is. OP-CPR can benefit patients and families by fulfilling the wish to donate. Specific (and very sensible-sounding) guidelines were suggested: In a brain-dead organ donor: CPR is acceptable without specific informed consent. If brain death has yet to be determined, BUT the patient had a known wish to donate: CPR would only be acceptable with a specific informed consent from the next of kin. If futility of treatment has not been established, OR it is uncertain if the patient wished to be an organ donor, then OP-CPR should be prohibited, in order to avoid any conflict of interest.

• #63 How Should Clinicians Respond When Patients’ Loved Ones Do Not See “Brain Death” as Death? | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/how-should-clinicians-respond-when-patients-loved-ones-do-not-see-brain-death-death/2020-12

  Religious or cultural values sometimes conflict with medical standards of practice or law. These conflicts frequently occur at the end of life when stress and tensions are high and, if not handled carefully, can escalate and cause tremendous pain. […] By listening, engaging religious leadership, supporting hospital staff, and practicing cultural humility, clinicians can often identify a care plan for patients who are brain dead that is sensitive to both medical standards of practice and personal religious and cultural values. […] The family should continue to be listened to and shown compassion. […] It is crucial for medical practitioners to establish a collaborative, trusting relationship with the familys rabbinic leadership. […] For those remaining on the care team, it becomes essential to reiterate the importance of cultural humility and the fact that defining life and death are philosophical concepts, not just medical criteria.

• #64

  https://journals.lww.com/neur/fulltext/2018/66020/brain_death_revisited.5.aspx

  Acceptance of this approach would reduce human distress, lead to the rational use of the limited ICU facilities, and increase the availability of organs. […] An effective communication with the family members, as well as caring and providing support for them is crucial before the request for organ donation is made. […] With the increasing availability of intensive care units even in Tier II and Tier III cities in India, a number of seriously ill patients are now being revived. […] It is imperative that all neurosurgeons and neurologists fully understand the intricacies of brain death so that they can discuss in detail with the family, the implications of continuing treatment and its repercussions.

• #65

  https://journals.lww.com/neur/fulltext/2018/66020/brain_death_revisited.5.aspx

  Acceptance of this approach would reduce human distress, lead to the rational use of the limited ICU facilities, and increase the availability of organs. […] An effective communication with the family members, as well as caring and providing support for them is crucial before the request for organ donation is made. […] With the increasing availability of intensive care units even in Tier II and Tier III cities in India, a number of seriously ill patients are now being revived. […] It is imperative that all neurosurgeons and neurologists fully understand the intricacies of brain death so that they can discuss in detail with the family, the implications of continuing treatment and its repercussions.

• #66 How Should Clinicians Respond When Patients’ Loved Ones Do Not See “Brain Death” as Death? | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/how-should-clinicians-respond-when-patients-loved-ones-do-not-see-brain-death-death/2020-12

  Religious or cultural values sometimes conflict with medical standards of practice or law. These conflicts frequently occur at the end of life when stress and tensions are high and, if not handled carefully, can escalate and cause tremendous pain. […] By listening, engaging religious leadership, supporting hospital staff, and practicing cultural humility, clinicians can often identify a care plan for patients who are brain dead that is sensitive to both medical standards of practice and personal religious and cultural values. […] The family should continue to be listened to and shown compassion. […] It is crucial for medical practitioners to establish a collaborative, trusting relationship with the familys rabbinic leadership. […] For those remaining on the care team, it becomes essential to reiterate the importance of cultural humility and the fact that defining life and death are philosophical concepts, not just medical criteria.

• #67

  https://journals.lww.com/neur/fulltext/2018/66020/brain_death_revisited.5.aspx

  Cerebral angiography, particularly a four-vessel angiogram, that demonstrates an absent cerebral circulation remains the gold-standard supplementary test for the diagnosis of brain-death. […] The other confirmatory tests include: Loss of bioelectric brain activity for at least 30 minutes of recording, as measured by a 16 or 18-channel EEG, is a reliable confirmatory test for the diagnosis of brain death. […] The use of multimodal evoked potentials in the diagnosis of brain-death has been described. […] The plethora of gadgetry ultimately only gives answers of dubious reliability to the wrong questions! […] Brain death has created a new class of dead people that does not conform to the society’s expectations of normal death and dying. […] Once an unequivocal diagnosis of brain death has been made, most medical and legal authorities agree that continuing treatment is not in the interest of the patient or is ethically permissible.

• #68 How Should Clinicians Respond When Patients’ Loved Ones Do Not See “Brain Death” as Death? | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/how-should-clinicians-respond-when-patients-loved-ones-do-not-see-brain-death-death/2020-12

  Religious or cultural values sometimes conflict with medical standards of practice or law. These conflicts frequently occur at the end of life when stress and tensions are high and, if not handled carefully, can escalate and cause tremendous pain. […] By listening, engaging religious leadership, supporting hospital staff, and practicing cultural humility, clinicians can often identify a care plan for patients who are brain dead that is sensitive to both medical standards of practice and personal religious and cultural values. […] The family should continue to be listened to and shown compassion. […] It is crucial for medical practitioners to establish a collaborative, trusting relationship with the familys rabbinic leadership. […] For those remaining on the care team, it becomes essential to reiterate the importance of cultural humility and the fact that defining life and death are philosophical concepts, not just medical criteria.

• #69 How Should Clinicians Respond When Patients’ Loved Ones Do Not See “Brain Death” as Death? | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/how-should-clinicians-respond-when-patients-loved-ones-do-not-see-brain-death-death/2020-12

  Religious or cultural values sometimes conflict with medical standards of practice or law. These conflicts frequently occur at the end of life when stress and tensions are high and, if not handled carefully, can escalate and cause tremendous pain. […] By listening, engaging religious leadership, supporting hospital staff, and practicing cultural humility, clinicians can often identify a care plan for patients who are brain dead that is sensitive to both medical standards of practice and personal religious and cultural values. […] The family should continue to be listened to and shown compassion. […] It is crucial for medical practitioners to establish a collaborative, trusting relationship with the familys rabbinic leadership. […] For those remaining on the care team, it becomes essential to reiterate the importance of cultural humility and the fact that defining life and death are philosophical concepts, not just medical criteria.

• #70 How Should Clinicians Respond When Patients’ Loved Ones Do Not See “Brain Death” as Death? | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/how-should-clinicians-respond-when-patients-loved-ones-do-not-see-brain-death-death/2020-12

  While decisions are made on a case-by-case basis, taking various crucial details into account, most rabbinic leaders are reasonable and can help find a workable approach. […] Jewish law sometimes permits withholding life-prolonging interventions in dying patients since it is passive. […] This approach often allows families to feel less culpable in their loved ones death and that they have maintained their integrity in adhering to Jewish law while caring for a family member. […] If compassion, trust, and a positive working relationship have been established from the outset, conflict is much more likely to be mitigated than in situations when that relationship has not been developed. […] The challenge is whether a health care institution can remain true to its commitment to evidence-based practice while respecting patients right to allow their cultural values to play a determining role in their lives.

• #71 How Should Clinicians Respond When Patients’ Loved Ones Do Not See “Brain Death” as Death? | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/how-should-clinicians-respond-when-patients-loved-ones-do-not-see-brain-death-death/2020-12

  Religious or cultural values sometimes conflict with medical standards of practice or law. These conflicts frequently occur at the end of life when stress and tensions are high and, if not handled carefully, can escalate and cause tremendous pain. […] By listening, engaging religious leadership, supporting hospital staff, and practicing cultural humility, clinicians can often identify a care plan for patients who are brain dead that is sensitive to both medical standards of practice and personal religious and cultural values. […] The family should continue to be listened to and shown compassion. […] It is crucial for medical practitioners to establish a collaborative, trusting relationship with the familys rabbinic leadership. […] For those remaining on the care team, it becomes essential to reiterate the importance of cultural humility and the fact that defining life and death are philosophical concepts, not just medical criteria.

• #72 How Should Clinicians Respond When Patients’ Loved Ones Do Not See “Brain Death” as Death? | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/how-should-clinicians-respond-when-patients-loved-ones-do-not-see-brain-death-death/2020-12

  While decisions are made on a case-by-case basis, taking various crucial details into account, most rabbinic leaders are reasonable and can help find a workable approach. […] Jewish law sometimes permits withholding life-prolonging interventions in dying patients since it is passive. […] This approach often allows families to feel less culpable in their loved ones death and that they have maintained their integrity in adhering to Jewish law while caring for a family member. […] If compassion, trust, and a positive working relationship have been established from the outset, conflict is much more likely to be mitigated than in situations when that relationship has not been developed. […] The challenge is whether a health care institution can remain true to its commitment to evidence-based practice while respecting patients right to allow their cultural values to play a determining role in their lives.

• #73 The intractable problems with brain death and possible solutions | Philosophy, Ethics, and Humanities in Medicine | Full Text

  https://peh-med.biomedcentral.com/articles/10.1186/s13010-021-00107-9

  The main reasons for accepting BD as death have been to free up scarce intensive care beds and resources, and to allow vital organ donation without the procurement killing the patient. […] Considering BD to be death is no longer necessary in order to withdraw life-support. […] Abandoning the dead donor rule in the setting of BD is likely the best course in moving forward.

• #74 The intractable problems with brain death and possible solutions | Philosophy, Ethics, and Humanities in Medicine | Full Text

  https://peh-med.biomedcentral.com/articles/10.1186/s13010-021-00107-9

  Brain death has been accepted worldwide medically and legally as the biological state of death of the organism. Nevertheless, the literature has described persistent problems with this acceptance ever since brain death was described. […] We argue that the best solution is to abandon the dead donor rule, thus allowing vital organ donation from patients currently diagnosed as BD, assuming appropriate changes are made to the consent process and to laws about killing. […] We must take the science of death and dying seriously: the criterion of BD does not meet any acceptable concept of death. […] As currently diagnosed, BD cannot be said to be the state with lack of all brain functions. Moreover, BD is not currently possible to diagnose due to confounders. […] We have argued that BD is not the biological death of the human organism, and even if it was, we cannot make the diagnosis accurately in practice.

• #75 Controversy over the definition of brain death : Shots – Health News : NPR

  https://www.npr.org/sections/health-shots/2024/02/11/1228330149/brain-death-definition

  The debate is focused on the Uniform Determination of Death Act, a law that was adopted by most states in the 1980s. The law says that death can be declared if someone has experienced „irreversible cessation of all functions of the entire brain.” […] But some parts of the brain can continue to function in people who have been declared brain dead, prompting calls to revise the statute. […] For years, doctors have declared brain death using a series of tests to determine four main criteria: whether a person has a profound and irreversible coma, has permanently lost the capacity to breathe, has permanently lost all reflexes controlled by the brainstem, and whether all potentially reversible conditions, such as a drug overdose, have been ruled out. […] But other parts of the brain may continue to function. Specifically, attention has focused on the hypothalamus, which helps manage very basic bodily functions like temperature, blood pressure and hormones.

• #76 Controversy over the definition of brain death : Shots – Health News : NPR

  https://www.npr.org/sections/health-shots/2024/02/11/1228330149/brain-death-definition

  Critics point to rare cases like Jahi McMath, a 13-year-old girl who was declared brain dead in 2013. […] Many other neurologists, bioethicists and others argue that there’s no way to make sure every neuron in the brain has ceased functioning. […] „They do not have any hope for meaningful recovery or any hope for regaining of consciousness or brainstem function,” says Dr. David Greer, chair of neurology at the Boston University Chobanian Avedisian School of Medicine. […] „There has never, ever been a case of a person correctly diagnosed as brain dead where that person has recovered any degree of consciousness,” agrees Dr. Robert Truog, a Harvard University professor of bioethics, anesthesiology and pediatrics. […] Some doctors and advocates would like to do away with brain death entirely. Others call for additional testing to rule out functioning of the hypothalamus.

• #77 Controversy over the definition of brain death : Shots – Health News : NPR

  https://www.npr.org/sections/health-shots/2024/02/11/1228330149/brain-death-definition

  Critics point to rare cases like Jahi McMath, a 13-year-old girl who was declared brain dead in 2013. […] Many other neurologists, bioethicists and others argue that there’s no way to make sure every neuron in the brain has ceased functioning. […] „They do not have any hope for meaningful recovery or any hope for regaining of consciousness or brainstem function,” says Dr. David Greer, chair of neurology at the Boston University Chobanian Avedisian School of Medicine. […] „There has never, ever been a case of a person correctly diagnosed as brain dead where that person has recovered any degree of consciousness,” agrees Dr. Robert Truog, a Harvard University professor of bioethics, anesthesiology and pediatrics. […] Some doctors and advocates would like to do away with brain death entirely. Others call for additional testing to rule out functioning of the hypothalamus.

• #78 Reversing brain death: Far-fetched or feasible?

  https://www.medicalnewstoday.com/articles/319035

  Though it sounds similar to the makings of fiction, scientists have received approval for the first ever trial that aims to restore neuronal activity in humans who have been declared brain dead. […] Using this combinatorial approach, the researchers hope to move subjects from a brain dead state into a coma state, effectively bringing them back to life. […] Pastor and team believe that their controversial trial represents the first step toward the regeneration of neurons and the restoration of neuronal functioning in humans. In essence, they believe that they could one day achieve what most people perceive to be unachievable: restoring life to the clinically dead. […] Our main hope is that this trial will show us that the gray zone between deep coma and irreversible coma is indeed just that gray, and that, with the tools of 21st century regenerative medicine, that there are possibilities to push that transition in the opposite direction to save lives, as well as begin a new chapter in the treatment of the wide range of consciousness disorders coma, persistent vegetative state, locked-in syndrome, etc., said Pastor.

• #79 Reversing brain death: Far-fetched or feasible?

  https://www.medicalnewstoday.com/articles/319035

  Though it sounds similar to the makings of fiction, scientists have received approval for the first ever trial that aims to restore neuronal activity in humans who have been declared brain dead. […] Using this combinatorial approach, the researchers hope to move subjects from a brain dead state into a coma state, effectively bringing them back to life. […] Pastor and team believe that their controversial trial represents the first step toward the regeneration of neurons and the restoration of neuronal functioning in humans. In essence, they believe that they could one day achieve what most people perceive to be unachievable: restoring life to the clinically dead. […] Our main hope is that this trial will show us that the gray zone between deep coma and irreversible coma is indeed just that gray, and that, with the tools of 21st century regenerative medicine, that there are possibilities to push that transition in the opposite direction to save lives, as well as begin a new chapter in the treatment of the wide range of consciousness disorders coma, persistent vegetative state, locked-in syndrome, etc., said Pastor.

• #80 Reversing brain death: Far-fetched or feasible?

  https://www.medicalnewstoday.com/articles/319035

  If this first phase of the Reanima Project is successful, Pastor said that the team will then attempt to restore independent breathing and heartbeat to each patient. Yielding a subject that is no longer technically dead anymore, the next step is continue on with patients through the disorders of consciousness spectrum, to an eventual state of wakefulness, he added.

• #81 Brain Death & Donation after Circulatory Death — LifeSource

  https://www.life-source.org/partners/hospitals/brain-death/

  Brain death is the irreversible cessation of all brain activity, including the brain and brain stem. The brain dies from lack of blood/oxygenation. Brain death is death. […] The doctors have done all they can to treat the patient’s condition. However, the brain will not recover function, and the patient is considered dead. A brain death diagnosis is final and cannot be reversed. […] If a vented patient is brain dead, LifeSource will arrive at the hospital, clinically manage the patient and further evaluate specific organs. LifeSource will match donated organs to transplant physicians on behalf of their waiting patients, per UNOS policy. […] The health care team’s key role is to help the family understand brain death and end of life decisions, and support the family. Families will be provided the amount of time they need to say goodbye to their loved one. […] Brain dead patients also sometimes experience spinal reflexes, which originate from the spinal nerves, not the brain or brainstem. This means that healthcare professionals and families may see some movement of extremities. This should not be confused with brain activity.

• #82 :: JKMS :: Journal of Korean Medical Science

  https://jkms.org/DOIx.php?id=10.3346/jkms.2020.35.e71

  Brain death is a clinical diagnosis that implies irreversible loss of function of the entire brain, including the brainstem and both hemispheres. […] However, reports of the frequency and common types of these movements vary from study to study. Thus, we evaluated adult patients with impending brain death in Korea to determine the frequency and characteristics of reflex and spontaneous movements. […] A total of 436 patients who met the criteria for brain death were enrolled during the study period. Of these patients, 74 (17.0%) exhibited either reflex or spontaneous movements. […] The most common reflex movements were the flexor/extensor plantar response and spinal myoclonus. […] Movements associated with brain dead patients are not rare and thus an awareness of these movements is important to brain death diagnosis.

• #83 :: JKMS :: Journal of Korean Medical Science

  https://jkms.org/DOIx.php?id=10.3346/jkms.2020.35.e71

  Brain death is a clinical diagnosis that implies irreversible loss of function of the entire brain, including the brainstem and both hemispheres. […] However, reports of the frequency and common types of these movements vary from study to study. Thus, we evaluated adult patients with impending brain death in Korea to determine the frequency and characteristics of reflex and spontaneous movements. […] A total of 436 patients who met the criteria for brain death were enrolled during the study period. Of these patients, 74 (17.0%) exhibited either reflex or spontaneous movements. […] The most common reflex movements were the flexor/extensor plantar response and spinal myoclonus. […] Movements associated with brain dead patients are not rare and thus an awareness of these movements is important to brain death diagnosis.

• #84 Brain Death & Donation after Circulatory Death — LifeSource

  https://www.life-source.org/partners/hospitals/brain-death/

  Brain death is the irreversible cessation of all brain activity, including the brain and brain stem. The brain dies from lack of blood/oxygenation. Brain death is death. […] The doctors have done all they can to treat the patient’s condition. However, the brain will not recover function, and the patient is considered dead. A brain death diagnosis is final and cannot be reversed. […] If a vented patient is brain dead, LifeSource will arrive at the hospital, clinically manage the patient and further evaluate specific organs. LifeSource will match donated organs to transplant physicians on behalf of their waiting patients, per UNOS policy. […] The health care team’s key role is to help the family understand brain death and end of life decisions, and support the family. Families will be provided the amount of time they need to say goodbye to their loved one. […] Brain dead patients also sometimes experience spinal reflexes, which originate from the spinal nerves, not the brain or brainstem. This means that healthcare professionals and families may see some movement of extremities. This should not be confused with brain activity.

• #85 :: JKMS :: Journal of Korean Medical Science

  https://jkms.org/DOIx.php?id=10.3346/jkms.2020.35.e71

  Physicians who perform brain death examinations should understand the frequency and characteristics of these movements to reduce delays in determining brain death. […] The occurrence of reflex and spontaneous movements in brain dead patients is not rare but previous studies of this phenomenon that employed relatively similar designs showed different results. […] If medical staff have sufficient knowledge of the frequency and patterns of these movements in patients with impending brain death, they may be better able to reduce delays in the diagnosis of brain death.

• #86 Medical Management of Brain-Dead Organ Donors

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6849043/

  Appropriate medical management of a potential organ donor is a very important issue, requiring a multidisciplinary team approach for successful organ transplantation. For graft survival after donation, all available organs in the donor need to be maintained at their normal physiological condition until the time of organ retrieval. Intensivists play a vital role in the management of potential organ donors through the identification of potential donors, declaration of brain death, and proper medical care, all of which can improve the rates of graft survival. […] Data shows that progression from brain death to somatic death results in the loss of 10% to 20% of potential donor tissues, therefore timely treatment of the donor is very crucial. Strict organ-protective intensive care of the potential organ donor is therefore the first step towards a successful transplant and in the treatment of the future organ recipient.

• #87 Medical Management of Brain-Dead Organ Donors

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6849043/

  Appropriate medical management of a potential organ donor is a very important issue, requiring a multidisciplinary team approach for successful organ transplantation. For graft survival after donation, all available organs in the donor need to be maintained at their normal physiological condition until the time of organ retrieval. Intensivists play a vital role in the management of potential organ donors through the identification of potential donors, declaration of brain death, and proper medical care, all of which can improve the rates of graft survival. […] Data shows that progression from brain death to somatic death results in the loss of 10% to 20% of potential donor tissues, therefore timely treatment of the donor is very crucial. Strict organ-protective intensive care of the potential organ donor is therefore the first step towards a successful transplant and in the treatment of the future organ recipient.

• #88 Medical Management of Brain-Dead Organ Donors

  https://www.accjournal.org/journal/view.php?doi=10.4266/acc.2019.00430

  With improving healthcare services, the demand for organ transplants has been increasing daily worldwide. Deceased organ donors serve as a good alternative option to meet this demand. The first step in this process is identifying potential organ donors. Specifically, brain-dead patients require aggressive and intensive care from the declaration of brain death until organ retrieval. Currently, there are no specific protocols in place for this, and there are notable variations in the management strategies implemented across different transplant centers. […] Intensivists play a vital role in the management of potential organ donors through the identification of potential donors, declaration of brain death, and proper medical care, all of which can improve the rates of graft survival. The protocol we have proposed and provided in the checklist may help intensivists in managing brain-dead organ donors to promote successful organ and tissue donation. […] Our proposed guideline (shown below) will help other centers to prepare their own management protocols for proper management of potential organ donors. This will increase chances of successful transplantations in the future.

• #89 Management of Brain-Dead Donor for Organ Transplant : Virtual Library

  https://resources.wfsahq.org/atotw/management-of-brain-dead-donor-for-organ-transplant/

  Organ transplantation is the treatment of choice for end-organ failure. Organs are sourced from living donors, donors declared dead by cardiopulmonary criteria, or donors declared brain dead by neurologic criteria. […] The ventilation, infusion and pumping, pharmacological treatment and specificities (VIPPS) strategy is a mnemonic method that brings together key aspects of the restoration of oxygen delivery to tissues during hemodynamic instability plus organ optimization strategies. […] Organ-preserving cardiopulmonary resuscitation is defined as the use of cardiopulmonary resuscitation in cases of cardiac arrest to preserve organs for transplantation, rather than to revive the patient. […] Declaration of brain death and subsequent management of potential donors for organ transplant along with obtaining the consent of the family for procurement is a highly sensitive issue and requires consideration and multidisciplinary effort by the hospital staff and the organ procurement team.

• #90 Brain Death | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/18522

  Once brain death has been diagnosed, the patient is clinically and legally declared deceased at the time of completion of brain death testing. At this time, depending on family and patient preference, cardiopulmonary support should be withdrawn, or arrangements for organ harvest should commence. Adequate documentation of all criteria of the diagnosis of brain death must be included in the patient’s medical record. It is recommended that some form of checklist be used to ensure the completeness of brain death testing.[10] […] The designation of brain death involves an interprofessional team. Nurses, physicians, social workers, and clergy will play a vital role in coordinating with families during the process of brain death examination and counseling after the diagnosis has been made. Subspecialists, such as intensivists, neurologists, or neurosurgeons, are required to interpret the physical examination findings, and radiologists may be necessary to interpret ancillary testing if the clinical diagnosis is inconclusive. While the diagnosis is considered, an interprofessional team specially trained in organ procurement should be involved; these specialty teams should handle all aspects of care only once the diagnosis of brain death has officially been made to ensure adequate protection for the team that cared for the patient until the diagnosis of brain death.[27] By adhering to the guidelines of clinical evaluation, ethical considerations, legal responsibilities, interprofessional collaboration, and effective communication, healthcare professionals can provide comprehensive and compassionate care in managing brain death scenarios. This approach ensures that patients and their families receive the highest standard of care significantly improves outcomes, and strengthens team performance in this complex and sensitive area of medical practice.

• #91 Brain Death | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/18522

  Once brain death has been diagnosed, the patient is clinically and legally declared deceased at the time of completion of brain death testing. At this time, depending on family and patient preference, cardiopulmonary support should be withdrawn, or arrangements for organ harvest should commence. Adequate documentation of all criteria of the diagnosis of brain death must be included in the patient’s medical record. It is recommended that some form of checklist be used to ensure the completeness of brain death testing.[10] […] The designation of brain death involves an interprofessional team. Nurses, physicians, social workers, and clergy will play a vital role in coordinating with families during the process of brain death examination and counseling after the diagnosis has been made. Subspecialists, such as intensivists, neurologists, or neurosurgeons, are required to interpret the physical examination findings, and radiologists may be necessary to interpret ancillary testing if the clinical diagnosis is inconclusive. While the diagnosis is considered, an interprofessional team specially trained in organ procurement should be involved; these specialty teams should handle all aspects of care only once the diagnosis of brain death has officially been made to ensure adequate protection for the team that cared for the patient until the diagnosis of brain death.[27] By adhering to the guidelines of clinical evaluation, ethical considerations, legal responsibilities, interprofessional collaboration, and effective communication, healthcare professionals can provide comprehensive and compassionate care in managing brain death scenarios. This approach ensures that patients and their families receive the highest standard of care significantly improves outcomes, and strengthens team performance in this complex and sensitive area of medical practice.

• #92 Brain Death | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/18522

  Once brain death has been diagnosed, the patient is clinically and legally declared deceased at the time of completion of brain death testing. At this time, depending on family and patient preference, cardiopulmonary support should be withdrawn, or arrangements for organ harvest should commence. Adequate documentation of all criteria of the diagnosis of brain death must be included in the patient’s medical record. It is recommended that some form of checklist be used to ensure the completeness of brain death testing.[10] […] The designation of brain death involves an interprofessional team. Nurses, physicians, social workers, and clergy will play a vital role in coordinating with families during the process of brain death examination and counseling after the diagnosis has been made. Subspecialists, such as intensivists, neurologists, or neurosurgeons, are required to interpret the physical examination findings, and radiologists may be necessary to interpret ancillary testing if the clinical diagnosis is inconclusive. While the diagnosis is considered, an interprofessional team specially trained in organ procurement should be involved; these specialty teams should handle all aspects of care only once the diagnosis of brain death has officially been made to ensure adequate protection for the team that cared for the patient until the diagnosis of brain death.[27] By adhering to the guidelines of clinical evaluation, ethical considerations, legal responsibilities, interprofessional collaboration, and effective communication, healthcare professionals can provide comprehensive and compassionate care in managing brain death scenarios. This approach ensures that patients and their families receive the highest standard of care significantly improves outcomes, and strengthens team performance in this complex and sensitive area of medical practice.

• #93 Brain Death | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/18522

  Once brain death has been diagnosed, the patient is clinically and legally declared deceased at the time of completion of brain death testing. At this time, depending on family and patient preference, cardiopulmonary support should be withdrawn, or arrangements for organ harvest should commence. Adequate documentation of all criteria of the diagnosis of brain death must be included in the patient’s medical record. It is recommended that some form of checklist be used to ensure the completeness of brain death testing.[10] […] The designation of brain death involves an interprofessional team. Nurses, physicians, social workers, and clergy will play a vital role in coordinating with families during the process of brain death examination and counseling after the diagnosis has been made. Subspecialists, such as intensivists, neurologists, or neurosurgeons, are required to interpret the physical examination findings, and radiologists may be necessary to interpret ancillary testing if the clinical diagnosis is inconclusive. While the diagnosis is considered, an interprofessional team specially trained in organ procurement should be involved; these specialty teams should handle all aspects of care only once the diagnosis of brain death has officially been made to ensure adequate protection for the team that cared for the patient until the diagnosis of brain death.[27] By adhering to the guidelines of clinical evaluation, ethical considerations, legal responsibilities, interprofessional collaboration, and effective communication, healthcare professionals can provide comprehensive and compassionate care in managing brain death scenarios. This approach ensures that patients and their families receive the highest standard of care significantly improves outcomes, and strengthens team performance in this complex and sensitive area of medical practice.

• #94

  https://link.springer.com/article/10.1007/s12055-021-01224-y

  Organ transplantation is a life-saving intervention for patients suffering from end-stage organ failure, but it relies on the availability of donor organs. However, even when donors are available, the brain-dead organ donor is a clinically complex patient who presents many management challenges. Donor management with a goal of optimization of organ function is essential to maximizing the number of patients who can be helped by each individual donor. Thoughtful critical care management of the potential organ donor, with a focus on meeting donor management goals, can lead to improved donation outcomes. […] […] Brain death and its implications for management of the potential organ donor. […] […] Thyroid hormone therapy in the management of 63,593 brain-dead organ donors: a retrospective analysis. […] […] A randomized trial of intravenous thyroxine for brain-dead organ donors with impaired cardiac function.

• #95

  https://link.springer.com/article/10.1007/s12055-021-01224-y

  Organ transplantation is a life-saving intervention for patients suffering from end-stage organ failure, but it relies on the availability of donor organs. However, even when donors are available, the brain-dead organ donor is a clinically complex patient who presents many management challenges. Donor management with a goal of optimization of organ function is essential to maximizing the number of patients who can be helped by each individual donor. Thoughtful critical care management of the potential organ donor, with a focus on meeting donor management goals, can lead to improved donation outcomes. […] […] Brain death and its implications for management of the potential organ donor. […] […] Thyroid hormone therapy in the management of 63,593 brain-dead organ donors: a retrospective analysis. […] […] A randomized trial of intravenous thyroxine for brain-dead organ donors with impaired cardiac function.

• #96 Management of Brain-Dead Donor for Organ Transplant : Virtual Library

  https://resources.wfsahq.org/atotw/management-of-brain-dead-donor-for-organ-transplant/

  The United Network for Organ Sharing (UNOS) Critical Pathway for the Organ Donor suggests a protocol of hormone replacement therapy (HRT) of levothyroxine, insulin, methylprednisolone, and possibly vasopressin when indicated. HRT has been found to improve cardiac graft outcomes. […] Organ preservation is a continuum which starts with the optimal management of the potential organ donor and continues during procurement and storage with the aim of increasing the likelihood of procurement in potential donors, the yield of transplantable organs per donor, and improving graft function after transplantation.

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